Free NPTE-PT Test Neuromuscular System Interventions Questions and Answers — Questions and Answers
Question 1: A patient with a T4 spinal cord injury suddenly complains of a pounding headache, and the physical therapist notes profuse sweating and flushing of the skin above the level of the lesion. The therapist measures the patient's blood pressure and finds it to be significantly elevated. Which of the following should be the therapist's IMMEDIATE course of action?
- Continue with the planned therapeutic exercise to see if the symptoms subside.
- Lay the patient down flat to help lower their blood pressure.
- Sit the patient upright, loosen any restrictive clothing, and check for noxious stimuli. (Correct answer)
- Administer a prescribed fast-acting vasodilator without further assessment.
Correct answer: Sit the patient upright, loosen any restrictive clothing, and check for noxious stimuli.
The patient is exhibiting classic signs of autonomic dysreflexia, a medical emergency common in individuals with spinal cord injuries at T6 or above. The initial and most crucial steps are to sit the patient upright to help lower blood pressure via orthostatic hypotension, remove any tight clothing or binders, and then immediately search for and remove the offending noxious stimulus, which is most commonly a distended bladder or bowel. Laying the patient flat would dangerously increase their blood pressure. Continuing exercise or administering medication without first trying to remove the stimulus is inappropriate.
Question 2: A physical therapist is developing a plan of care for a patient with Parkinson's disease who experiences frequent freezing of gait (FOG) when walking through doorways. Which of the following interventions has the strongest evidence for immediately improving this specific impairment?
- Strengthening exercises for the lower extremities using heavy resistance.
- Prolonged static stretching of the hip flexors and calf muscles.
- Endurance training on a stationary bicycle for 30 minutes.
- Using visual and auditory cues, such as stepping over lines on the floor or walking to a metronome beat. (Correct answer)
Correct answer: Using visual and auditory cues, such as stepping over lines on the floor or walking to a metronome beat.
Evidence strongly supports the use of external cueing strategies to overcome freezing of gait in patients with Parkinson's disease. Visual cues (like lines on the floor) and rhythmic auditory stimulation (like a metronome or music) provide an external rhythm that helps bypass the dysfunctional internal rhythm generation in the basal ganglia, facilitating movement initiation and continuation. While strengthening, stretching, and endurance are important components of a comprehensive plan, they do not directly address the motor-planning deficit that causes freezing episodes as effectively as cueing strategies.
Question 3: A patient is in Stage 3 of Brunnstrom's stages of recovery following a stroke. Which of the following clinical findings is MOST characteristic of this stage?
- The patient's affected limbs are completely flaccid with no voluntary movement.
- The patient begins to demonstrate movement that is not dominated by synergistic patterns.
- The patient exhibits marked spasticity and can perform voluntary movements only within synergy patterns. (Correct answer)
- Spasticity begins to decrease, and isolated joint movements become possible.
Correct answer: The patient exhibits marked spasticity and can perform voluntary movements only within synergy patterns.
Brunnstrom's Stage 3 is characterized by the peak of spasticity. During this stage, the patient gains voluntary control of the abnormal movement synergies that appeared in Stage 2, but they are unable to move outside of these stereotyped patterns. Flaccidity is Stage 1. Moving outside of synergy patterns begins in Stage 4, which is also when spasticity starts to decrease.
Question 4: A physical therapist is treating a patient with chronic unilateral vestibular hypofunction. According to the most recent clinical practice guidelines, which intervention is MOST appropriate to improve gaze stability?
- Voluntary smooth pursuit eye movements without head movement.
- Habituation exercises focusing on positions that provoke mild dizziness.
- Gaze stabilization exercises (X1 viewing) performed for at least 20 minutes daily. (Correct answer)
- Static balance activities on a foam surface with eyes closed.
Correct answer: Gaze stabilization exercises (X1 viewing) performed for at least 20 minutes daily.
The updated clinical practice guidelines for unilateral vestibular hypofunction strongly recommend gaze stabilization exercises, such as VOR x1 viewing (keeping eyes focused on a target while turning the head), to promote gaze stability. For chronic conditions, a minimum daily duration of 20 minutes is recommended. The guidelines specifically recommend AGAINST using smooth pursuit or saccadic eye movements in isolation (without head movement) for this purpose. While habituation and balance exercises are important components of vestibular rehabilitation, gaze stabilization exercises specifically target the impairment of gaze stability.
Question 5: A patient who has had a right-hemisphere stroke consistently pushes strongly with their left arm and leg, leaning to their paretic right side and resisting any attempts at passive correction to midline. Which intervention strategy is MOST appropriate for this patient?
- Passively pushing the patient back to the midline position repeatedly.
- Having the patient practice reaching for objects on their strong (left) side.
- Using a mirror to provide visual feedback of their body position and alignment. (Correct answer)
- Strengthening the left-side musculature to prevent over-pushing.
Correct answer: Using a mirror to provide visual feedback of their body position and alignment.
This patient is demonstrating 'pusher syndrome' or lateropulsion, a condition where their perception of vertical is skewed. The most effective interventions focus on helping the patient become aware of their altered posture. Using visual feedback, such as a mirror or aligning themselves with a vertical reference like a doorframe, allows them to see the mismatch between their perceived vertical and true vertical, facilitating active correction. Passively pushing them often increases their resistance. Reaching to the strong side would reinforce the pushing behavior. Strengthening the non-paretic side is not the primary issue; the problem is one of altered perception of verticality.
Question 6: A physical therapist is working with a patient who has Multiple Sclerosis (MS) and reports debilitating fatigue as their primary complaint. Which of the following represents the BEST evidence-based approach to managing this patient's fatigue?
- Advising the patient to take frequent, prolonged rest periods and avoid all exercise.
- Focusing solely on passive range of motion and modalities to conserve energy.
- Implementing a customized program of aerobic and light resistance exercise. (Correct answer)
- Recommending energy drinks and supplements to boost energy levels.
Correct answer: Implementing a customized program of aerobic and light resistance exercise.
Contrary to what might seem intuitive, research consistently shows that an appropriately designed exercise program is one of the most effective non-pharmacological interventions for managing MS-related fatigue. A combination of aerobic conditioning and resistance training can improve energy levels, endurance, and overall function. Advising complete rest can lead to deconditioning, which worsens fatigue. Passive modalities do not address the underlying physiological factors contributing to fatigue, and recommending supplements is outside the physical therapist's scope of practice.
Free NPTE-PT Test Neuromuscular System Interventions Questions and Answers
A patient with a T4 spinal cord injury suddenly complains of a pounding headache, and the physical therapist notes profuse sweating and flushing of the skin above the level of the lesion.
The therapist measures the patient's blood pressure and finds it to be significantly elevated.
Which of the following should be the therapist's IMMEDIATE course of action?